Intracoronary Infusion of Dilute Ethanol for Control of Ventricular Rate in Patients with Atrial Fibrillation

The effects of selective infusion of 25% ethanoi into the AV nodal artery was assessed in 1J putients with atriai fibrillation and uncontrollabiy rapid ventricular response rates. The primary study objective was to achieve permaneni modificafion of AV nodal function and control ventricular rate without drug therapy and mthout causing permanent complete AV block. “Clinical success” was defined as drug-free rate control by either AV nodal modification or the production of complete AV block. Selective catheterization and ethanol infusion into the AV nodal artery could be performed in nine patients. Jntracoronary ethanol infusion acutely caused second- or third-degree AV noda] block in seven palients and an increase in AV nodal refractory period and Wenckebach cycle length in two patients. Acute occlusion of the AV nodal artery or infarction of nontarget myocardium was not observed. During follow-up of 22.2 ± 2.2 months the primary study objective was attained in only four of nine patienfs treated, yielding an efficacy of 44%. However, the “clinical success” rate was 78%. The acute effects of ethanol on AV conduclion did not predict the chronic effects. Selective intracoronary infusion of dilute ethanol lo control the ventricular rate in atrial fibrillation should be considered when rodiofrequency ablation has been unsuccessful. This method of chemical ablation is as effective and probably safer than rapid administration of 96% ethanol.